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Illinois rates for HCPCS A5056

Ostomy pouch, drainable, with extended wear barrier attached, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.67 / $3.67 / $3.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.05 / $3.67 / $6.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.69 / $37.84 / $75.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.83 / $4.90 / $4.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.93 / $3.93 / $7.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.34 / $3.93 / $7.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.82 / $7.12 / $9.19
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.49 / $8.49 / $8.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.33 / $8.16 / $9.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $3.26 / $5.59